Mucosal Grafts and Flaps in Draf IIb and Draf III: A Systematic Review and Meta‐analysis

Abstract Objective To evaluate the impact of mucosal grafts and flaps on neo‐ostium patency and clinical outcomes in patients undergoing Draf IIb or III frontal sinus drill‐out procedures. Data Sources A systematic search was conducted across PubMed, Medline, Cochrane Library, Scopus, and Web of Science databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Review Methods Following PRISMA guidelines, consecutive studies were included, and a meta‐analysis was performed. Study characteristics, patient demographics, surgical outcomes, and neo‐ostium patency rates were extracted. Pooled relative risks (RRs) and mean differences (MDs) were estimated using random‐effects models. Publication bias was evaluated via funnel plots and Egger's test. Results Nine studies with 375 patients undergoing mucosal reconstruction were included, following 116 (30.9%) Draf IIb and 259 (69.1%) Draf III procedures. Four comparative studies were eligible for meta‐analysis. Draf III was performed in 97.2% of cases (n = 318), with 165 (51.9%) patients in the flap group and 153 (48.1%) in the no‐flap group. Mean follow‐up was 41.3 ± 9.5 months. Mucosal flaps/grafts significantly improved neo‐ostium patency (RR 1.087, 95% CI: 1.018‐1.159, P = .011) and reduced loss of neo‐ostium area (MD 19.52%, 95% CI: 9.97‐29.06, P < .01). Clinical outcomes, including polyp scores and patient‐reported measures, showed high heterogeneity, limiting synthesis. Conclusion Mucosal reconstruction may enhance neo‐ostium patency but could only be analyzed for Draf III. Variability in study design and outcome reporting remains a limitation. Standardized methodologies are essential to accurately assess the role of mucosal grafting in frontal sinus surgery.